Provider Demographics
NPI:1083238802
Name:SHAPE TO SUCCESS
Entity Type:Organization
Organization Name:SHAPE TO SUCCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KASSI
Authorized Official - Middle Name:
Authorized Official - Last Name:METZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:732-322-9985
Mailing Address - Street 1:23 MANALAPAN RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08884-1658
Mailing Address - Country:US
Mailing Address - Phone:732-322-9985
Mailing Address - Fax:
Practice Address - Street 1:23 MANALAPAN RD
Practice Address - Street 2:
Practice Address - City:SPOTSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08884-1658
Practice Address - Country:US
Practice Address - Phone:732-322-9985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities